Charge Module Design, Implementation, and Troubleshooting November 11, 2011 Presenter: Tracy Kimble

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Objectives Why implement charge? Organization considerations How is this supposed to work? Getting started – system configuration –Creating group builds –Charge-related dictionaries –Charge admin options –Preferences –TWUser Admin settings Outpatient charges January 24, 20144

Why Implement Charge? Utilization for meaningful use reporting Increased Revenue & Accelerated Cash Flow –Faster submission = faster reimbursement Improved Efficiency –Dual entry is eliminated –Easy, immediate updates to encounter forms –Enhanced personalization options Internal organizational reporting –Tasks auto created for providers –Easier to spot trends with reportable data Personalization of Super Bill via Favorites January 24, 20145

Organization Issues Change makes end-users uneasy & this is a BIG change Involving money & affects many people in the organization–administrators, providers, & business office Not going to fix a bad process but will bring poor workflow to light – opportunity to examine & redesign Need for testing & planning can NOT be over-stated Involve end-users from across the organization Work closely with clinical staff to identify task teams & responsibilities early in the design process Periodic review & process modification needed January 24, 20146

Organization Decisions Is your organization going to: –Bring up charge after implementation of other AEHR modules? –Or, at the time of deployment? Implementation strategy: Are you going to utilize a site by site approach or will you roll out by specialty? –Specialties use the same sets of codes –Sites may share support personnel across specialties January 24, 20147

How Does the Charge Module Work? Appt made in the PMS resides on provider schedule in pending status until the date of service Appt is arrived in the PMS and message flows through interface –Causes appt to show as arrived on the providers schedule –Creates Submit Enc Form task for the scheduled provider January 24, 20148

From the Note Provider creates note and completes visit as appropriate Assessed problems flow to Encounter Form Procedures, medications & immunizations that are set up to will flow to EF If organization utilizes E&M coder, the Office Visit charge can flow to the EF if set up is completed January 24, 20149

From the Encounter Form Verify all info listed is correct – modify, delete, and amend as necessary Submit charges to resolve the Submit Enc Form task –If end-user submitting is on direct submit, the EF will flow through interface to PM –If end-user is not on direct submit, subsequent task is created for review by coding/billing users Coder reviews EF via task views & submits when satisfied requirements have been met for billing Locking of the EF is not based on billing provider, but on the preference of the end-user in conjunction with system settings January 24,

Workflow Demo January 24,

Getting Started Meet with coding department (enterprise or specialty) –Look at current Super Bills –Run reports from PMS to get accurate numbers Additional clinical input needed Understand both clinical and business workflow –Why are they doing what they do? Can workflows be streamlined? –Do they use dummy codes, dummy providers, or resource schedules (ie: nurse or chemo chars)? January 24,

Additional Considerations Appointments vs Non-appointments Look at your visit types: Are some non-billable? Does your PMS limit the number of dx codes that can be submitted? –Some carriers limit dx to 4, 8 or 10 codes –Be sure to inform end-users of decisions and reasoning How are demographics & FSC info sent to the AEHR? Good time for modification & standardization January 24,

How Do We Implement Charge? Depends on PMS & TES –Get vendor specs for interface messages –What types of edits can be written in TES? –How does your organization want to handle changes to the EF? Gather super-bills & convert to electronic encounter forms Define & create groups Ask for feedback from departments & re-work groupings Be prepared to get creative! January 24,

Define & Create Groups Sub-Group Set Up –Diagnosis –Procedures –Visit Charges Exploding Sets –Create the grouping with dx, procedure, & visit –Link to appropriate groups –Modify charge details for number of units & appropriate modifiers –Set the display order of exploding set Manage Groups – Assign groups Modifier Groups – only modifiers assigned to a group will be available for selection by end-users utilizing those builds on the front end January 24,

Application Set-up Demo January 24,

Charge-Related Dictionaries ICD9 Charge Code CPT4 Modifiers Division Billing Area Billing Location Appointment Types Discount Type Encounter Type Injury Type & Qualifier and Injury Context Qualifier January 24,

ICD9, CPT4, and Modifiers ICD9 Diagnosis –When linked to problems (Problem dictionary) ICD9 code sent to Charge via Note based on assessed problems by providers –Loaded from the PMS through SSMT, automated update process, or manually entered directly in the dictionary Charge Code (CPT4) –Charge Type – Multiple Unites, Time Based, etc –Visit Code/25 Modifiers –Age/Gender restrictions Modifiers (CPT4 Modifiers) –Visit, Procedure, Both –CCI Modifier January 24,

Orderable Item Dictionary Charge M/N section –Set the When to Charge option appropriately –Link billable CPT4 codes –Include charges for medications (and generic equivalents) along with administration codes –Issues with charges not dropping to encounter forms Can include other options –Display code, description, administration fees Keep careful records of orders set to charge As CPTs are marked inactive in PMS, OID must be manually updated January 24,

Additional Charge-Related Dictionaries Division Billing Area Billing Location Appointment Types Discount Type Encounter Type Injury Type & Qualifier and Injury Context Qualifier January 24,

Charge Administration Map providers PDA task set-up Configurable fields Enterprise preferences –Some found also with Order preferences –ABNs & Medical Necessity User preferences Compliance Code set-up Additional Info set-up January 24,

Mapping Providers Options that are displayed on encounter header in charge module Reflect only those options that are available in your PMS Not keeping in synch will result in interface or PMS errors Always verify your options have been saved January 24,

Enterprise Preferences CCI – Correct Coding Initiative 25 Modifier checking Free text referring provider Non-billable dx codes Compliance code field, defaults & required Medical necessity Hold for ABN Encounter locking & lock timeout HCC – Hierarchical Condition Category Checking January 24,

Additional Info Set-up Set condition based on variety of criteria –Chg Code, Dx, Division, Billing Area or Location, FSC, Injury type, and Patient Age or Sex (limited to 3) Can be set to line item charge or the entire encounter Answer type & inputs can be controlled Red frowny face on encounter form Examples: NDC, Date Last Seen, Disability Dates, LMP, Prior Auth Number, Referral Number, etc. January 24,

System Preferences Admin preferences for charge – 3 to be set TWAdmin preferences – CreateFutureEnc Personalizations on encounter form tab –Auto Link of Dx(s) to Charges –Display when Submit Button is activated –For Diagnosis, Visit and Procedure tabs Default selection method Display controls Sort order Number of columns January 24,

TWUser Admin Uncheck the Dont Generate Send Charges Tasks when starting provider on charge module. Generates the Submit Enc Form task for arrived appointments Billing Provider – allows you to map your provider in Charge Admin Preferences for Product – Enterprise EHR –ChgWorksCreateRevEncFormTasks Always – Review Enc Form Task generated Never – no Review Task; EF will lock if preference set Inpatient – varies by organization –Large number of other preference – can be set through SSMT January 24,

Additional Considerations Importance of syncing PMS & EHR –ICD9 –Billing locations, areas, divisions options while mapping providers –Visit Type –Encounter Type –What to do when its time to update/deactivate codes in PMS User favorites Inpatient – Varies by organization –Technical fees –Professional fees –Facility fees January 24,

Also to consider… Charges not dropping to correct EF and how to correct them Decide on a workflow to handle charge-related problems –What are you going to do if charges need to be added to an already-submitted invoice? –What are you going to do when codes need to be changed? –How are you going to handle visits not billed to a primary insurance? January 24,

Questions? Contact us through our website at GALEN